Subject Numbers Regarding Health Provider Authorizations

Authorization No. 135796-1W

March 31, 2017

Pursuant to Workers' Compensation Law Section 13-d(5), the Chair of the New York State Workers' Compensation Board has exercised his authority to revoke Dr. Clifford Jacobson’s authorization to treat injured workers within the New York State workers’ compensation system effective April 1, 2017. Dr. Jacobson's last known business addresses are 1655 Elmwood Avenue, Rochester, New York 14620, and 72 Drexel Drive, Rochester, New York 14606.

The revocation is based upon Consent Order (BPMC No. 17-063), issued by the New York State Department of Health, State Board for Professional Medical Conduct (BPMC), effective March 7, 2017, wherein Dr. Jacobson’s license to practice medicine was limited pursuant to Public Health Law §230-a(3) precluding him from prescribing controlled substances during the period from the effective date of the Order (March 7, 2017) through March 31, 2017, at which time his license will be surrendered. Dr. Jacobson’s surrender of license is based on factual allegations that include failure to document an adequate medical history, failure to document appropriate medical indications for controlled substances prescribed for multiple patients, and for diagnosing and/or treating a patient for PTSD and/or generalized anxiety disorder without documenting adequate medical indication for one or both of those diagnoses.

Dr. Jacobson had his authorization to treat injured workers temporarily suspended by the Board on April 2, 2013.

Dr. Jacobson is prohibited from rendering treatment and care to injured workers. Reports submitted by Dr. Jacobson for services rendered prior to April 2, 2013 are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Jacobson for services rendered prior to April 2, 2013, should not be denied due to the temporary suspension and subsequent revocation of his authorization.

Any questions regarding the authorized lists should be referred to the Medical Director’s Office at 1 (800) 781-2362.